Thorac Cardiovasc Surg 2016; 64 - OP148
DOI: 10.1055/s-0036-1571593

Complexity of Coronary Artery Disease and Revascularization Quality in Off-pump versus on-Pump Surgery - Single-Center Analysis from the GOPCABE Study

K. Preindl 1, A. Zittermann 1, D. Diaz 1, K. Hakim-Meibodi 1, S. Ensminger 1, A. Diegeler 2, J. Gummert 1, J. Börgermann 1
  • 1Herz- und Diabeteszentrum NRW, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
  • 2Herz- und Gefäß-Klinik Bad Neustadt/Saale, Klinik für Kardiochirurgie, Bad Neustadt / Saale, Germany

Background: Revascularization quality in off-pump versus on-pump coronary surgery is an ongoing and hotly debated issue. This is due to the fact that some randomized studies have shown higher re-revascularization rates, a lower number of peripheral anastomoses and more incomplete revascularizations in off-pump groups. In this single-center analysis from the German Off-Pump Coronary Artery Bypass in the Elderly (GOPCABE) study, revascularization quality is investigated in connection with the complexity of the CAD.

Methods: 323 patients aged 75 years or above who underwent isolated CABG at our center were randomized. The complexity of the CAD was quantified in the off-pump and on-pump groups using the SYNTAX Score. The primary endpoints of the study were completeness of revascularization (number of grafts, index of completeness of revascularization (ICOR)), re-revascularization rates in the 4-year follow-up and re-angiography findings, the last being systematically analyzed according to the FitzGibbon and Thrombolysis in Myocardial Infarction Scoring (TIMI) systems.

Results: After 4 years there was no difference between the groups regarding survival or MACCE (death, myocardial infarction, stroke). The complexity of the CAD according to the number of lesions and SYNTAX Score was comparable in the off-pump and on-pump groups (4.21 ± 1.51 versus 5.05 ± 7.96, p = 0.330; 20.4 ± 7.42 versus 21.3 ± 7.84, p = 0.452, respectively). Here the number of peripheral anastomoses performed (2.71 ± 0.68 versus 2.68 ± 0.74, p = 0.570), ICOR (number of grafts performed/number of grafts intended, 0.89 ± 0.23 versus 0.90 ± 0.22, p = 0.723) and the re-revascularization rate (6.8% versus 8.0, p = 0.734) in the 4-year follow-up were not significantly differently. 29 (8,97%) of the patients underwent re-angiography. In the off-pump group 1 stenosed and 28 occluded grafts were found, compared with 5 stenosed and 18 occluded grafts in the on-pump group (see Table 1).

Conclusion: In this single-center analysis from the GOPCABE study, there were no significant differences between off-pump and on-pump surgery regarding complexity of the coronary artery disease and revascularization quality.

Table 1 Angiographic graft patency scores